Ann Rehabil Med.  2013 Apr;37(2):286-290. 10.5535/arm.2013.37.2.286.

Novel Influenza A (H1N1)-Associated Acute Necrotizing Encephalopathy: A Case Report

• Kim KJ
• Park ES
• Chang HJ
• Suh M
• Rha DW

• KMID: 2165784
• DOI: http://doi.org/10.5535/arm.2013.37.2.286

Abstract

Several cases of acute necrotizing encephalopathy (ANE) with influenza A (H1N1) have been reported to date. The prognosis of ANE associated with H1N1 is variable; some cases resulted in severe neurologic complication, whereas other cases were fatal. Reports mostly focused on the diagnosis of ANE with H1N1 infection, rather than functional recovery. We report a case of ANE with H1N1 infection in a 4-year-old Korean girl who rapidly developed fever, seizure, and altered mentality, as well as had neurologic sequelae of ataxia, intentional tremor, strabismus, and dysarthria. Brain magnetic resonance imaging showed lesions in the bilateral thalami, pons, and left basal ganglia. To our knowledge, this is the first report of ANE caused by H1N1 infection and its long-term functional recovery in Korea.

Keyword

H1N1 subtype influenza A virus; Viral encephalitis; Humans influenza

MeSH Terms

Ataxia
Basal Ganglia
Brain
Dysarthria
Encephalitis, Viral
Fever
Influenza, Human
Korea
Magnetic Resonance Imaging
Pons
Prognosis
Seizures
Strabismus
Tremor

Figure

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  Fig. 1 (A) Brain magnetic resonance images (MRIs) taken on November 11, 2009 showing enhancing lesions in bilateral thalami, pons, and left basal ganglia, suggesting sequelae of previous viral infection in T2-weighted images. (B) Brain MRIs taken on January 8, 2010 showing a decrease in the extent of lesions involving bilateral thalami and brainstem with remaining hemorrhagic residues. (C) Brain MRIs taken on April 29, 2010 showing no interval change of hemorrhagic residues in dorsal brain stem and bilateral thalami.

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  Fig. 2 Left abducens nerve palsy was observed on January 11, 2010 (A) and was improved on April 15, 2010 (B).

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  Fig. 3 Fluorodeoxyglucose-positron emission tomography brain scan taken on December 28, 2009. Glucose uptake increased diffusely in bilateral basal ganglia and mildly in bilateral thalami, but decreased diffusely in bilateral cerebral hemispheres in both transverse (A) and coronal (B) sections.

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